Comparision of Intraperitoneal Instillation of Bupivacaine, Ropivacaine and Saline for Postoperative Pain Relief after Laparoscopic Intraabdominal Surgeries
Dr. Vandanaba L. Rathod 1*, Dr. Jagruti R. Satasia2
1.R3, Department of Anaesthesia, SCL General Hospital and Smt. NHL Medical College, Ahmedabad, Gujarat.
2.Associate Professor, Department of Anaesthesia, SCL General Hospital and Smt. NHL Medical College, Ahmedabad, Gujarat.
*Correspondence to: Dr. Vandanaba L. Rathod, R3, Department of Anaesthesia, SCL General Hospital and Smt. NHL Medical College, Ahmedabad, Gujarat.
© 2024: Dr. Vandanaba L. Rathod. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 07 August 2024
Published: 24 August 2024
Abstract
Introduction: Laparoscopic surgeries involve insufflation of gas usually carbon dioxide into peritoneal cavity producing a pneumoperitoneum. Although minimal invasive surgery is characterized by reduced pain but it is not painless. Patients undergoing laparoscopic surgery suffer considerable pain on the day of surgery frequently requiring narcotic analgesia. Intraperitoneal instillation of local anaesthetic in combination with General Anaesthesia for postoperative analagesia is a part of multimodal approach for pain control.
Aim & Objectives: To evaluate the efficacy of two different local anaesthetic Bupivacaine vs Ropivacaine in terms of
1. Duration of postoperative pain relief.
2. Need of rescue Analgesia in postoperative period.
3. Any side effects or complications.
Methodology: A Prospective, randomised, comparative case control study conducted on 60 Patients undergoing laparoscopic abdominal surgeries.
INCLUSION CRITERIA:
1. Adult patient of either sex
2. Age between 18 to 60 years
3. ASA grade I/ II
4. Patient posted for elective laparoscopic surgeries
5. Patient who had given informed written consent
EXCLUSION CRITERIA:
1. Patient not satisfying above inclusion criteria
2. ASA physical status III, IV AND V
3. Local anaesthetic allergy
4. Patients who refused
5. Pregnancy
6. Any laparoscopic surgery converted to open surgery
After explaining and taking informed written consent, pre-operative preparation were done, all drugs and instruments kept ready for cardio -pulmonary resuscitation. IV line secured. Non-invasive monitors and Etco2 monitor was applied. Before induction pre-operative vitals noted. General Anesthesia given.
The patients were devided into three comparative study groups
GROUP B: Bupivacaine group
GROUP R: Ropivacaine Group
GROUP C: Control Group
Results:
Ropivacaine provided adequate Analgesia of 11.5 hours compared to Bupivacaine which provided for 8 hours and control group which provided Analgesia for 5.5 hours. Ropivacaine provide Analgesia for longer duration as compared to other two groups.
Conclusion:
Ropivacaine provide most profound and prolonged analgesia as compared to Bupivacaine.
This technique of providing postoperative analagesia is simple, safe, effective and improves postoperative recovery profile of the patient.
Introduction
Laparoscopic surgeries involve insufflation of gas usually carbon dioxide into peritoneal cavity producing a pneumoperitoneum. Although Minimal Invasive Surgery is characterized by reduced pain but it is not painless. Patients undergoing laparoscopic surgery suffer considerable pain on the day of surgery frequently requiring analgesia1,2
Uncontrolled postoperative pain has an adverse sequel of delayed resumption of normal pulmonary function, restriction of mobility (thus contributing to thromboembolic complications), nausea and vomiting, increase in the systemic vascular resistance, cardiac work, and myocardial oxygen consumption through an increase in the catecholamine release induced by the stress response.3
Adequacy of postoperative pain control is one of the most important factors in determining when a patient can be safely discharged from surgical facility and has a major influence on the patient’s ability to resume their normal activities of daily living.4
Although traditionally the mainstay of postoperative analgesia is opioid based, increasingly more evidence exists to support a multimodal approach with the intent to reduce opioid side effects (such as nausea and paralytic ileus) and improve pain scores.5 Intraperitoneal instillation of local anaesthetic in combination with